Cognitive health

To help older adults protectbrain health and function,add activities that ensure aflow of novelty, variety andchallenge

by Álvaro Fernández, MA, MBA

By now you have probably heard aboutbrain plasticity, the lifelong capacity ofthe brain to change and rewire itself inresponse to the stimulation of learningand experience. The latest scientificresearch shows that specific lifestyles andactions can improve the health and levelof functioning of our brains, no matterour age.

Of particular importance to maintainingcognitive functioning through life are thehippocampus (deep inside the brain, partof what is called the limbic system),which plays a role in learning and mem-ory; and the frontal lobes (behind yourforehead), which are key to maintainingdecision-making and autonomy. Is therea way to physically protect these parts ofthe aging brain? Yes. But the right answeris far from “do one more crossword puz-zle” or “do more X” (whatever X is). Thekey is to add significantly different activi-ties to ensure a flow of novelty, varietyand challenge, combining physical andmental exercise while not ignoring factorssuch as stress management and balancednutrition.1

We need, in other words, to retool ourunderstanding and practice of “Use it orlose it.” We must focus on the impor-tance of getting out of our physical andmental routines and activities to get thebenefits of real exercise—physical andmental.

Healthy brain aging:why we need to retool‘Use it or lose it’

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Debunking 10 commonmythsThe extensive research process we undertook for our recent book, TheSharpBrains Guide to Brain Fitness,1 high-lighted the need to debunk some popularmyths on brain health that may hinderefforts in the right direction. Theseinclude:

Myth 1. Genes determine the fate of our brains.Facts: Lifelong neuroplasticity allows ourlifestyles and actions to play a meaningfulrole in how our brains physically evolve,especially given longer life expectancy.

Myth 2. Aging means automatic decline.Facts: There is nothing inherently fixedin the precise trajectory of how brainfunctions evolve as we age.

Myth 3. Medication is the main hope forcognitive enhancement.Facts: Noninvasive interventions canhave comparable and more durableeffects, side effect-free.

Myth 4. We will soon have a magic pill orgeneral solution to solve all our cognitivechallenges.Facts: A multipronged approach is rec-ommended, centered around nutrition,stress management, and both physicaland mental exercise.

Myth 5. There is only one “it” in “Use it orlose it.”Facts: The brain is composed of a num-ber of specialized units. Our life and productivity depend on a variety of brain functions, not just one.

Myth 6. All brain activities or exercises are equal.Facts: Varied and targeted exercises arethe necessary ingredients in brain train-ing, so that a wide range of brain func-tions can be stimulated.

Myth 7. There is only one way to train your brain.Facts: Brain functions can be impacted ina number of ways, such as meditation,cognitive therapy and cognitive training.

Myth 8. We all have something called“brain age.”

There are four types of mental exercisewith more supporting scientific evidencethat they can enhance specific brainfunctions.1 They are:

• Cognitive therapy (CT). The way weperceive our experiences influences ourbehaviors, and we can learn cognitiveskills to modify our thinking, resultingin actions. CT is commonly used inthe context of anxiety and depression,but its core principles and techniquesshow promise in a variety of otherapplications such as healthy eating.

• Meditation. This practice has beenshown to improve specific cognitivefunctions such as attention and emo-tional self-regulation.

Facts: Brain age is a fiction. No two indi-viduals have the same brain or expressionof brain functions.

Myth 9. That “brain age” can be reversedby 10, 20, 30 years.Facts: Brain training can improve specificbrain functions, but, with research avail-able today, cannot be said to roll backone’s “brain age” by a number of years.

Myth 10. All human brains need the samebrain training.Facts: As in physical fitness, users mustask themselves: What functions do I needto improve on? In what timeframe? Whatis my budget?

With these facts in mind, let’s delve intodifferent types of mental exercise andhow they benefit the brain.

Exercise requires cross-training and challengeThe most common enemies of novelty,variety and challenge are routine anddoing things inside our comfort zones.This is true for both physical and mentalexercise.

Consider the type of mental exerciseexperienced daily by London cab drivers.Every new ride requires a complex men-tal task to decide the most efficient routeto complete the continually novel chal-lenge at hand. Contrast that with theroutine mental activity (we couldn’t reallycall it “mental exercise”) undertaken byLondon bus drivers who, day after day,follow a precise itinerary. Clearly, if youlived in London and wanted to protectand even grow your hippocampus, youwould choose to drive a cab, not a bus.

Of course, the brain has a variety ofstructures and functions to maintain,well beyond the hippocampus, hence theneed for cross-training. Not all mentalexercise is equal in terms of its structuraland functioning benefits—in the sameway that different types of physical fit-ness training bring different benefits.Mental exercise strengthens the synapsesor connections between neurons (nervecells), thus improving neuron survivaland cognitive functioning. Rememberthat “cells that fire together wire together.”

Resource

The SharpBrains Guide to BrainFitness: 18 Interviews with Scientists,Practical Advice, and Product Reviews,to Keep Your Brain SharpAuthors: Álvaro Fernández andElkhonon Goldberg, PhDSan Francisco CA: SharpBrains Inc.,May 2009Paperback, 182 pages, $24.95

The SharpBrains Guide to BrainFitness is the result of over a year ofextensive research including morethan 100 interviews with scientists,professionals and consumers, and adeep literature review. Among theleading scientists interviewed, ArthurKramer explains the need for walkingbook clubs and Yaakov Stern discussesbuilding cognitive reserve. There is anaccessible introduction to the brainand brain fitness research combinedwith over 100 references to peer-reviewed scientific studies for deeperstudy. The resource also reviews 21products for brain cross-training, tar-geted mental exercise, and emotionalself-regulation.

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Healthy brain aging: why we need to retool ‘Use it or lose it’ Continued from page 41

• Biofeedback. A growing number ofrelatively inexpensive devices canmeasure and graphically display vari-ous physiological variables such asheart rate variability, so that users canlearn to self-adjust and identify andmanage emotions better.

• Brain Fitness Software. These fullyautomated applications are designedto assess and enhance specific cogni-tive abilities. This is the area that hasexploded since 2007—and where weobserve the most confusion since dif-ferent packages tend to target differentfunctions (e.g., working memory,auditory processing, divided attention)in ways that are not transparent orunderstood by users.

Yet, even mental cross-training isn’tenough on its own. What else is neededto maintain the complex system of thebrain?

Brain-friendly livingForget a magic pill. Healthy brain agingrequires a brain-friendly lifestyle, in addi-tion to mental cross-training. This life-style should at least include:1

• Balanced nutrition. As a generalguideline, what is good for the bodyand heart is also good for the brain.Gingko biloba and other supplementsdo not seem to bring the benefits peo-ple expect.

• Stress management. Chronic stressreduces and can even inhibit neuroge-nesis (the creation of new neurons)and affects memory and other brainfunctions. It is then important tolearn how to manage stress.

• Physical exercise. Physical exerciseimproves cognitive functioningthrough increased blood supply andgrowth hormone levels in the brain.Of all the types of physical exercise,cardiovascular exercise that gets the

heart beating has been shown to havethe greatest effect.

• Overall mental stimulation.Cumulated mental stimulationthroughout our lives (via education,jobs, leisure activities) can help build a neuroprotective cognitive reservethat can help delay the onset ofAlzheimer’s-related symptoms.

Healthy, active living—with a focus ongood health in all the dimensions of wellness—is the kind of brain-friendlylifestyle that can help protect cognitivefunction across the life span.

Implications for active-agingprofessionalsActive aging is one of the areas wherethis type of brain research can make aprofound difference in years to come.While much more research needs to bedone to identify the right type of cogni-tive exercise to improve the daily func-tioning of any given individual, it isbeyond reasonable doubt that novelty,variety and challenge contribute tohealthy brain aging better than commonalternatives (more passive or repetitivepastimes).

1. Target users: Who among yourclients is ready and willing to do theprogram? How are they reacting tothe pilot testing of the activities?

2. Cognitive benefits: What are thespecific benefits claimed for usingeach program? Under what scenarioof use (how many hours/week, howmany weeks)? What specific cogni-tive skill(s) does the program train?How will you measure progress?

3. Appropriate challenge: Do the exer-cises adjust to the individual andcontinually vary and challenge resi-dents at an appropriate pace?

4. Scientific credentials: Are there sci-entists, ideally neuropsychologists,behind the program? Is there aclearly defined and credible scien-tific advisory board? Are there

published, peer-reviewed scientificpapers?

5. Return on investment: What areyour key objectives, and how will youindependently measure the progressdue to this program to expand, main-tain or change course?

6. Total cost of ownership: What maybe the total cost of ownership overthe next three to five years if you gowith different vendors: upfront fees,ongoing fees, hardware, software,training and support fees, cost ofadditional modules and staff time?How many clients will likely end upusing the system, and therefore whatis the cost of ownership per user?

7. Technical requirements: What arethe technical requirements needed tosuccessfully deploy and maintain the

program? Does it require anInternet connection? Who willhelp solve potential glitches?

8. Staff training: What type of train-ing will you and your staff need,and who will provide it?

9. References: What similar organiza-tions have used this specific pro-gram? What proportion of theirclients use it regularly? What bene-fits have they measured and ob-served in their clients, and as anorganization? Is the use of the pro-gram growing, or is it flat ordeclining?

10. Product road map: What is theproduct roadmap for this compa-ny? What is the company develop-ing and planning to offer next year,and in two to three years?

SharpBrains’ checklist for providers evaluating brain fitness programs

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Active-aging organizations can easily pro-vide quality information for staff andclients and create a library of programsand activities to assist each person infinding an appropriate program—notnecessarily with budget implications.Depending on the setting, older adults,or their families, can buy the programsbased on the available information andfirsthand testing.

Finding the right mix between structure,science and fun involves trying options.There is no panacea, or program thatworks best for everyone. Some peopleprefer “fun games,” while others prefermore structured sessions or a more sci-ence-based approach.

Some options for mental exercise requirepurchasing a device. Others requireinstalling software in PCs in existing ornew computer labs, or are fully availableonline. And still others may be technolo-gy-free, promising engaging combina-tions of interactive, group-based activitieswith pen-and-paper exercises.

Can you, the ambassadors of active agingand brain fitness, incorporate novelty,variety and challenge into your work set-tings, and help reshape and retool “Use itor lose it” for your clients?

Álvaro Fernández, MA, MBA, recentlycoauthored The SharpBrains Guide toBrain Fitness: 18 Interviews withScientists, Practical Advice, and ProductReviews, to Keep Your Brain Sharp, withneuropsychologist Elkhonon Goldberg, PhD.Fernández is the CEO of SharpBrains Inc.,and a member of the World EconomicForum’s Global Agenda Council on theAging Society. For more information aboutSharpBrains, visit www.sharpbrains.com.

Reference

1. Fernández, A., & Goldberg, E. (2009). TheSharpBrains Guide to Brain Fitness: 18 Interviewswith Scientists, Practical Advice, and ProductReviews, to Keep Your Brain Sharp. San FranciscoCA: SharpBrains Inc.

How can you navigate this landscape? Noprogram available today currently offers adream combination of ideal characteris-tics, so you need to take into accountyour specific circumstances, priorities and budget. That’s why we suggest youlaunch a pilot and measure results inobjective, independent ways beforeembarking on major rollouts. As you pre-pare your business case, try using theSharpBrains checklist on page 42 toselect and introduce a new toolkit forcognitive exercise.

Ready for the future?Based on our market research work, wesee clear signs of a growing “Culture ofBrain Fitness,” with a better integrationof physical and mental exercise and evenmainstream awareness and broad initia-tives. Better tools to assess cognitivefunctions and to improve brain functionsare underway. And more actors will takebrain fitness into consideration—think ofphysicians, psychologists, insurance com-panies, on top of residential communitiesand seniors centers.

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